A trial is underway on North Dakota’s ban on gender-affirming care for kids

North Dakota Republican state Rep. Bill Tveit works at his desk on Wednesday, Jan. 22, 2025, in the House of Representatives at the state Capitol in Bismarck, N.D. (AP Photo/Jack Dura)

BISMARCK, N.D. — A trial in a lawsuit seeking to strike down North Dakota’s ban on gender-affirming medical care for minors began Monday, more than a year after families of transgender children and a doctor filed the suit that argued the law violates the state’s constitution.

North Dakota is one of more than two dozen states that have banned gender-affirming care. Like North Dakota, many of those states have faced court challenges to the laws.

“This case is not as complicated as it may seem,” said lead counsel Brittany Stewart, senior staff attorney at Gender Justice, a nonprofit advocating gender equity. “All North Dakotans have a right to personal autonomy to make decisions about the health care they need or don’t need to live happy, healthy lives as their authentic selves.”

Court rulings have significantly reduced the scope of the North Dakota case, filed in late 2023. Earlier this month, a state district judge dismissed from the case some of the claims as well as the children and families who were plaintiffs, leaving only a pediatric endocrinologist as a plaintiff.

The trial in Bismarck, the state capital, is expected to last eight days. It’s unclear when the judge will rule.

Then-Gov. Doug Burgum signed the bill into law in April 2023 after it overwhelmingly passed the Republican-led Legislature. It makes it a misdemeanor for a health care provider to prescribe or give hormone treatments or puberty blockers to a transgender child, and a felony to perform gender-affirming surgery on a minor.

Special Assistant Attorney General Joe Quinn said the law is a constitutional regulation that the Legislature “has the power to do, has the right to do and it has the responsibility to do,” with “no definitive evidence to support medical gender transition care.”

Lawmakers who supported the bill that became law said it would protect children from what they said are irreversible treatments and operations.

“We were creating an atmosphere where if you felt you had that situation, that you were of that mentality, that we would go ahead and cut off body parts and affirm where you’re at without trying to guide you through it,” said Republican Rep. Bill Tveit, who introduced the bill. “Maybe it was a wrong thought at that age, and if you want to make that decision when you’re of age ... that’s your prerogative once you’re an adult.”

He said he hopes the trial’s outcome affirms the law.

Opponents said the legislation would have harmful effects on transgender kids, and noted that gender-affirming surgeries are not performed on minors in North Dakota.

A U.S. Centers for Disease Control and Prevention survey last year found that transgender and gender-questioning teens reported higher rates of bullying at school than their peers and that about 1 in 4 transgender teens said they had attempted suicide in the past year.

Stewart said in an interview, “When you ban the only medically supported care for a specific condition and only for young people who are under 18, you’re not protecting those kids. You’re actively harming those children.”

The law contains an exemption for children who were already receiving treatments before the ban’s effective date. But attorneys for the plaintiffs said providers held off due to perceived vagueness in the law. That led the families to travel and miss work and school to seek care for their kids -- including an eight-hour round trip drive for one family to attend a 30-minute appointment, Stewart said.

The judge later said the law does not apply to any minors who were receiving gender-affirming care before North Dakota’s ban took effect, including the three plaintiff children. The judge said they “can receive any gender-affirming care they could have received” previously. But their access remains unchanged because that ruling was not enough of a final decision to satisfy attorneys for health care organizations, Stewart said.

At least two pediatric endocrinologists in North Dakota were providing gender-affirming care before the ban, Stewart said.

“As far as the number of patients, I can’t really say, but honestly whether it’s a lot or a few is really irrelevant to whether this is constitutional,” she said.

President Donald Trump recently signed an executive order declaring only two sexes, male and female, are recognized by the federal government. State laws on sports participation, bathroom use, gender-affirming care and other issues are not directly affected.

Every major U.S. medical group, including the American Academy of Pediatrics and the American Medical Association, has opposed such bans and said that gender-affirming treatments can be medically necessary and are supported by evidence. Research has further shown that transgender youths and adults can be prone to suicidal behavior when forced to live as the sex they were assigned at birth.

At least 26 states have adopted laws restricting or banning gender-affirming medical care for transgender minors, and most of those states face lawsuits. Federal judges have struck down the bans in Arkansas and Florida as unconstitutional, though a federal appeals court has stayed the Florida ruling. A judge’s order is in place temporarily blocking enforcement of the ban in Montana.

The states that have passed laws restricting or banning gender-affirming medical care for transgender minors include Alabama, Arkansas, Arizona, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia and Wyoming.

By Jack Dura

THE ASSOCIATED PRESS